Successful Treatment of Encapsulating Peritoneal Sclerosis With Immunosuppressive Therapy

Lafrance, Jean‐Philippe; Létourneau, Isabelle; Ouimet, Denis; Bonnardeaux, Alain; Leblanc, Martine; Mathieu, Nicole; Pichette, Vincent

doi:10.1053/j.ajkd.2007.07.036

Cited by 69 publications

(55 citation statements)

References 13 publications

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“…In Japan, enterolysis (surgical division of adhesions) is recommended but there are few European reports on EPS surgery (11)(12)(13)(14)(15). Case series have assessed total parenteral nutrition, immunosuppression and tamoxifen, and some have shown encouraging results (3,7,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). There are no reliable biochemical or radiologic screening tests to identify patients at risk or in the early stages of EPS (27,28).…”

mentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis in the New Millennium

Brown

Simpson

Kerssens

et al. 2009

Clinical Journal of the American Society of Nephrology

182

205

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mentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis in the New Millennium

Brown

Simpson

Kerssens

et al. 2009

Clinical Journal of the American Society of Nephrology

182

205

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“…18,21,24,31 In our study combination of steroid with an mTOR inhibitor failed to provide further protection against EPS than individual drugs achieved. This issue is especially important in managment of posttransplantation EPS in patients previously on PD.…”

Section: Discussionmentioning

confidence: 55%

“…There had been reports so far that revealed beneficial effects of various therapeutic agents, like N-acetyl cystein, rosiglitazone, renin angiosystem blockers, monotherapies with mTOR inhibitors, and steroids alone on EPS models. 8,20,21,24,25 This report is the rare kind of its that underlines the beneficial effect of sirolimus or prednisolone alone on EPS model, but no further improvement with combination however.…”

Section: Discussionmentioning

confidence: 82%

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The Effect of Steroid-Sirolimus Combination on the Experimental Model of Encapsulating Peritoneal Sclerosis in Rats

Ersan¹,

Çelik²,

Çelik³

et al. 2015

Turkiye Klinikleri J Nephrol

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Encapsulating peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis terminating with peritoneal sclerosis and coccooning of intestinal loops. The inhibitors of mammalian target of rapamycin (mTOR), everolimus and sirolimus, have attenuated EPS findings in experimental animal models. The effect of combination of sirolimus with steroid has not been documented so far. The aim of the study was to determine the effect of combination of sirolimus and steroid on experimental sclerosing peritonitis model. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 41 wistar albino male rats were divided into 6 groups : control group (C; isotonic saline injected intraperitoneally), chlorhexidine gluconate group (CG; model group), resting group (R; CG then peritoneal rest, prednisolone group (P; CG then prednisolone), sirolimus group (Sir; CG then sirolimus), and prednisolone-sirolimus group (P-Sir; CG then prednisolone plus sirolimus). Peritoneal specimens obtained after sacrification at the end of study were examined for peritoneal thickness, fibrosis, and vascular intensities under light microscopy. R Re es su ul lt ts s: : In the CG and R groups there was a significant increase in peritoneal thickness, fibrosis score and vascular intensity compared to C, P, Sir, and P-Sir groups in both parietal and visceral peritoneum (p<0.05). The parameters at the end of the study were not different in C, P, Sir, and P-Sir groups. The difference between P, Sir, and P-Sir groups were not significant. Resting was shown to be ineffective in attenuating EPS parameters. C Co on nc cl lu us si io on n: : In this study we observed that sirolimus-prednisolone combination was equally effective in experimental EPS model compared to prednisolone and sirolimus only regimens.K Ke ey y W Wo or rd ds s: : Peritonitis; sirolimus; models, animal; adrenal cortex hormones; peritoneal dialysis Ö ÖZ ZE ET T A Am ma aç ç: : Enkapsüle periton sklerozu (EPS), periton sklerozu ve intestinal segmentlerin koza şeklinde sarılması ile sonuçlanan ciddi bir periton diyalizi komplikasyonudur. Memelilerde rapamisin hedefi inhibitörleri (mTOR), everolimus ve sirolimus, deneysel hayvan modellerinde EPS bulgularını azaltmışlardır. Steroid-sirolimus kombinasyonunun etkisine yönelik yapılan bir çalışma bulunmamaktadır. Bu çalışmada deneysel sklerozon peritorit modelinde sirolimus ile steroid kombinasyon tedavisinin etkisini belirlemek amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : 41 wistar albino erkek sıçan 6 gruba ayrıldı: kontrol grubu (C; intraperitoneal izotonik serum), klorheksidin glukonat grubu (CG; model grup), dinlenme grubu (R; CG sonrası periton dinlenme), prednizolon grubu (P; CG sonrası prednizolon), sirolimus grubu (Sir; CG sonrası sirolimus) ve prednizolon-sirolimus grubu (P-Sir; CG sonrası prednizolon ve sirolimus). Periton örnekleri ışık mikroskobisi ile; periton kalınlığı, fibrozis skoru ve damar yoğunluğu için değerlendirildi. B Bu ul lg gu ul l...

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“…The profibrotic characteristics of these drugs are well documented [27,28]. On the contrary, mTOR inhibitors (sirolimus and everolimus) and mycophenolate mofetil do not share this negative action; in fact these immunosuppressive drugs have already been proposed as a therapy for EPS [29][30][31]. Moreover, to achieve a better outcome in kidney transplantation, many immunosuppressive protocols based on these drugs have been developed to prevent or to minimize the nephrotoxic effect of calcineurin inhibitors: with these new protocols most transplanted patients are managed successfully without a significant increase in rejection rate [32,33].…”

Section: Exploring Ways To Prevent Epsmentioning

confidence: 99%

No need for an “expiry date” in chronic peritoneal dialysis to prevent encapsulating peritoneal sclerosis

Garosi

Oreopoulos

2009

Int Urol Nephrol

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Encapsulating peritoneal sclerosis (EPS) is drawing attention to the PD community because of its unpredictable onset and high mortality.Recently, the Scottish Renal Registry [1] has established the incidence of EPS and its correlation with PD duration in that region. The rate of EPS among patients on PD was 1.5%, with an incidence of 4.9 per 1,000 person-years. This rate is well within those reported previously (0.7-3.3%) [2][3][4][5][6][7]. Interestingly, the EPS rate increased with longer duration of PD up to 5 years (from 0% at\1 year to 8.8% at[5 to 6 years), and then decreased (5% at[6 years). The median duration of PD before EPS developed was 5.1 years. At the time of diagnosis only 26% of patients with EPS were on PD. In the remainder (74%), EPS was diagnosed after PD had been discontinued; 50% of them were diagnosed with EPS after kidney transplantation with calcineurin inhibitor-based immunosuppression.

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Successful Treatment of Encapsulating Peritoneal Sclerosis With Immunosuppressive Therapy

Cited by 69 publications

References 13 publications

Encapsulating Peritoneal Sclerosis in the New Millennium

Encapsulating Peritoneal Sclerosis in the New Millennium

The Effect of Steroid-Sirolimus Combination on the Experimental Model of Encapsulating Peritoneal Sclerosis in Rats

No need for an “expiry date” in chronic peritoneal dialysis to prevent encapsulating peritoneal sclerosis

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